Surrogacy is a medically complex process, with procedures that are not always familiar to women who gave birth in the past. Surrogates are asked, sometimes, to make important medical decisions, some of which are standard and relevant to all pregnancy (like choosing natural childbirth vs. caesarean section) and some are unique to the surrogacy process. The surrogate should make her own medical decisions about her body and her health, but sometimes relevant medical information is not passed on to her in a full and understandable manner. This is the especially the case in countries in which there is a difference in culture, language and/or status between the surrogates and members of the medical system. Another reason could be the desire of the medical system to represent the intended parents, who finance the process (and pay their salaries), in cases where their interests might be different from those of the surrogate, such as decisions regarding the termination of pregnancy and choices between natural birth or C-sections. Some surrogacy agreements also impose a ban on surrogates to contact other physicians before and during pregnancy, so they have no real option to receive any second opinion.

We recommend making sure that all medical information is accessible to the surrogate, in a clear and timely manner and without bias. Additionally, it is worthwhile confirming that the details of the medical procedure, including regular treatments and tests, are detailed in the contract. In addition, we recommend that you make sure that the results of medical tests are delivered regularly to the surrogate. If parents suspect there might be some bias in the way information is transferred to the surrogate, they may consider providing the surrogate with access to a different doctor, which is independent of both the fertility clinic and the surrogacy agency. They can also allow the surrogate to choose her own physician. In this context, it should be noted that there are often two different doctors involved in the process – one handling the IVF and another following the ongoing pregnancy. Despite the fact that the doctor with which the surrogate interacts during the pregnancy is the latter, it should be noted that she is mostly exposed to the former during the primary stages of the process and surrogates sometimes do not meet the relevant physician at all until they are pregnant.

Note: The most important medical decision that the surrogate is required to make is, of course, her consent to participate in the process. Sometimes a woman’s medical condition does not allow her to be a surrogate – and it is important to confirm that the medical testings before the process were done in a proper, unbiased manner by a clinic that is not financially dependent on the agency of fertility clinic. This should be done avoid endangering women that may be negatively affected by the process. We also recommend that medical screening be conducted at an early stage, before a match between a potential surrogate and parents was made. This will prevent the heartache (to both sides) involved in a match that is broken due to medical inadequacy of the surrogate – and the temptation to attempt surrogacy against the medical recommendation in a manner risking all involved.